Copy multiple fields in a form to the same form for revisions

I have a set of fields in a form that are used to track permit application submissions and when revisions are required I'd like to be able to track the new revision without overwriting the values in the original fields. Ideally, when the "ULA-Status" field (Text - Multiple Choice) is set to "Revision Required" the entire set of fields would duplicate below the originals and have their values set to blank.